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NPI Code Detail

MEDICARE: BERNICE ALICE THEULE NP-C

MEDICARE: BERNICE ALICE THEULE NP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner4704194529MI

General Provider Information

NPI Number : 1679135958
Entity Type Code : Individual
Provider Name (Legal Business Name) : BERNICE ALICE THEULE NP-C
Provider Business Mailing Address
First Line : 100 MICHIGAN ST NE # MC845
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49503-2560
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2750 E BELTLINE AVE NE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49525-8614
Country : US
Telephone Number : 616-267-7015
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2019
Last Update Date : 05/26/2026

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